Information Collection

Report on Income and Expense, Rule 17a-10 (17 CFR 240.17a-10).

IC 34396 under ICR 202007-3235-001 · OMB 3235-0122.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3235-0122 can be found here:

Documents and Forms

Document Name Document Type
Form sec 1696 Report on Income and Expense, Rule 17a-10 (17 CFR 240.17a-10). Form
formx-17a-5_2a.pdf www.sec.gov/files/formx-17a-5_2a.pdf Instruction
sec 1696 FOCUS Report Part IIA formx-17a-5_2f.pdf www.sec.gov/files/formx-17a-5_2f.pdf Form
SEC 1675 X-17a-5 Schedule I formx-17a-5_schedi.pdf www.sec.gov/files/formx-17a-5_schedi.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Report on Income and Expense, Rule 17a-10 (17 CFR 240.17a-10).	Agency IC Tracking Number:	240-154

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 17 CFR 240.17a-10

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	sec 1696	FOCUS Report Part IIA	formx-17a-5_2f.pdf	https://www.sec.gov/files/formx-17a-5_2f.pdf	Yes	No	Printable Only
Instruction			formx-17a-5_2a.pdf	https://www.sec.gov/files/formx-17a-5_2a.pdf	Yes	No	Printable Only
Form and Instruction	SEC 1675	X-17a-5 Schedule I	formx-17a-5_schedi.pdf	https://www.sec.gov/files/formx-17a-5_schedi.pdf	Yes	No	Printable Only

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 46	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	46	8	38
Annual IC Time Burden (Hours)	552	96	456
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.